Featured Research

from universities, journals, and other organizations

Use of unproven mammography tool soars with Medicare coverage

Date:

June 14, 2010

Source:

University of California - Davis - Health System

Summary:

In a study illustrating the potentially powerful influence of political pressure on medical practice, a physician-researcher has found that use of a largely unproven mammography screening device has surged since Medicare began covering its cost.

Share This

In a study illustrating the potentially powerful influence of political pressure on medical practice, a UC Davis physician-researcher has found that use of a largely unproven mammography screening device has surged since Medicare began covering its cost.

Related Articles

Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine, with colleagues from the University of Washington and University of Minnesota, examined use of computer-aided detection (CAD), a medical device designed to help radiologists interpret mammograms, since Congress mandated that Medicare pay for it 10 years ago.

He found that the prevalence of CAD jumped from 5 percent in 2001 when Medicare began covering it, to 27 percent in 2003, the most recent year for which data was available. Extra mammography fees for CAD use cost Medicare an estimated $19.5 million in 2003 alone. But actual costs are probably greater because the device has been associated with higher recall rates and greater use of diagnostic tests such as breast biopsy.

The increase in computer-aided detection use occurred even though "systemic reviews point to uncertainty regarding whether CAD has a clinically important impact on key breast cancer outcomes," Fenton writes in the Archives of Internal Medicine.

The authors explain that Medicare coverage of the device was key to marketing the device to hospitals and health-care facilities, which resulted in intense lobbying of Congress for approval of CAD as a covered benefit.

"This illustrates how industry and government interact to determine the course of health-care practice, and it's not really guided by science," Fenton said. "This is a case in which expensive technology gets widely adopted in clinical practice before it is proven effective."

Computer-aided detection software analyzes the mammogram image and marks suspicious areas for radiologists to review. In a previous study of more than 200,000 women who had mammograms, published in the New England Journal of Medicine in 2007, Fenton and colleagues found that CAD produced excessive false-positive results. His research demonstrated that when it was used, 32 percent more women were recalled for additional tests and 20 percent more women had a breast biopsy, yet use of the software had no clear impact on the early detection of breast cancer.

"This argues that we need a way of evaluating technologies before we put them into practice," Fenton said. "The government has a huge stake in this. And once the train leaves the station, it's difficult to call it back."

In the current review, Fenton suggests that intense lobbying by manufacturers of the technology, combined with the politically volatile issue of breast cancer screening, resulted in fast-track approval by the government of Medicare coverage of the device. He also argues that industry representatives were better able to market the device, which require a large capital investment of over $100,000, after providers were assured their costs would be reimbursed by the government insurance program.

In an accompanying commentary in the same issue of the Archives, Karla Kerlikowske, professor of medicine, epidemiology and biostatistics at UC San Francisco, says health-care providers and others cannot presume that newer technologies are better than existing ones.

"Health-care providers should not adopt new technologies without first demanding scientific evidence beyond that required for FDA approval," she writes, adding that such evidence should include not just clinical benefits, but also important associated harms and whether benefits outweigh those harms.

Fenton's co-authors on the study include Susan Foote, professor emeritus of health policy and management at the University of Minnesota, and Pamela Green and Professor Laura-Mae Baldwin of the Department of Family Medicine at the University of Washington.

Mar. 31, 2015  Increasing state alcohol taxes could prevent thousands of deaths a year from car crashes, say researchers, who found alcohol-related motor vehicle crashes decreased after taxes on beer, wine and ... full story

Mar. 31, 2015  Alcoholism takes a toll on every aspect of a person's life, including skin problems. Now, a new research report helps explain why this happens and what might be done to address it. "The clinical ... full story

Mar. 31, 2015  A new population of 'memory' immune cells has been discovered by scientists, throwing light on what the body does when it sees a microbe for the second time. This insight, and others like it, will ... full story

Mar. 31, 2015  Coronary heart disease and stroke, two of the leading causes of death in the United States, are diseases associated with heightened platelet reactivity. A new study in humans suggests an underlying ... full story

Mar. 31, 2015  A new study had researchers seeking answers to why the therapeutic benefit afforded by SSRIs was so limited in children and teenagers. If researchers can uncover the biological mechanisms preventing ... full story

Mar. 31, 2015  A drug being developed to treat osteoporosis may also be useful for treating osteogenesis imperfecta or brittle bone disease, a rare but potentially debilitating bone disorder that that is present ... full story

Mar. 31, 2015  It is possible to quantify and classify the effects of different diseases on the activity of intestinal bacteria, new research demonstrates for the first time. Human intestinal flora, known as ... full story

Mar. 31, 2015  During prenatal development, the brains of most animals, including humans, develop specifically male or female characteristics. But scientists have known little about the details of how this ... full story

Mar. 31, 2015  A history of depression may put women at risk for developing diabetes during pregnancy, according to research. This study also pointed to how common depression is during pregnancy and the need for ... full story

Featured Videos

Solitair Device Aims to Takes Guesswork out of Sun Safety

Reuters - Innovations Video Online (Mar. 31, 2015)  The Solitair device aims to take the confusion out of how much sunlight we should expose our skin to. Small enough to be worn as a tie or hair clip, it monitors the user&apos;s sun exposure by taking into account their skin pigment, location and schedule. Matthew Stock reports.
Video provided by Reuters

Soda, Salt and Sugar: The Next Generation of Taxes

Washington Post (Mar. 30, 2015)  Denisa Livingston, a health advocate for the Dinι Community Advocacy Alliance, and the Post&apos;s Abby Phillip discuss efforts around the country to make unhealthy food choices hurt your wallet as much as your waistline.
Video provided by Washington Post

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015)  Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17
Video provided by AFP

Related Stories

Sep. 2, 2014  Questions regarding effectiveness, infrastructure and cost effectiveness of low-dose computed tomography (CT) screening of those at high risk for lung cancer have now been answered. Medicare should ... full story

July 16, 2014  Medicare spending on breast cancer screening increased substantially between 2001 and 2009 but the detection rates of early stage tumors were unchanged, according to a new study. The effect of ... full story

July 1, 2014  Breast cancer screening costs for Medicare patients in the United States skyrocketed between 2001 and 2009, but the increase did not lead to earlier detection of new breast cancer cases, according to ... full story

Nov. 27, 2012  Researchers assessing the impact of revised guidelines for screening mammography issued by the US Preventive Services Task Force found evidence that the new recommendations may lead to missed cancers ... full story

Oct. 1, 2010  The use of computer-aided detection (CAD) is increasing, in both screening and diagnostic mammography, according to a new study. CAD software systems highlight and alert the radiologist of abnormal ... full story

ScienceDaily features breaking news and videos about the latest discoveries in health, technology, the environment, and more -- from major news services and leading universities, scientific journals, and research organizations.